US8961594B2 - Heart valve repair system - Google Patents

Abstract

Techniques are described for use with one or more sutures. For some applications, techniques are described for fixedly-coupling two or more sutures to each other. For some applications, such techniques are used for treating a heart valve of a subject. Techniques are also described for treating a heart valve of a subject by coupling leaflets of the heart valve to a support using tissue-piercing elements. Other embodiments are also described.

Description

FIELD OF THE INVENTION

Some applications of the present invention relate in general to surgical techniques. More specifically, some applications of the present invention relate to techniques for securing sutures. More specifically, some applications of the present invention relate to transluminal techniques for securing sutures.

BACKGROUND

Functional tricuspid regurgitation (FTR) is governed by several pathophysiologic abnormalities such as tricuspid valve annular dilatation, annular shape, pulmonary hypertension, left or right ventricle dysfunction, right ventricle geometry, and leaflet tethering. Treatment options for FTR are primarily surgical. The current prevalence of moderate-to-severe tricuspid regurgitation is estimated to be 1.6 million in the United States. Of these, only 8,000 patients undergo tricuspid valve surgeries annually, most of them in conjunction with left heart valve surgeries.

SUMMARY OF THE INVENTION

In some applications of the invention, apparatus and methods are provided for fixedly coupling sutures to each other. For some such applications, the apparatus comprises a suture-securing device that comprises two tubular elements that are movably coupled to each other. For other such applications, the apparatus comprises a suture-securing device that comprises a casing and a core that are movably coupled to each other. Both suture-securing devices described have an unlocked configuration, in which sutures are generally slidable through the device, and a locking configuration, in which the sutures are generally not slidable through the device.

In some applications of the invention, the suture-securing devices are configured to be biased to moving toward the locking configuration thereof, and are retained in the unlocked configuration by a constraint. For such applications, the devices automatically move toward the locking configuration when the constraint is removed.

In some applications of the invention, techniques are provided for using the suture-securing device to repair a heart valve, by fixedly coupling together sutures that are coupled to different parts of the annulus of the valve.

In some applications of the invention, apparatus and methods are provided for repairing a heart valve by sandwiching valve leaflets between a support and a securing element, such that multiple orifices are formed between respective portions of the valve leaflets. Typically, the support is generally disc-shaped, and comprises a wire-mesh. Typically, the securing element comprises a plurality of arms, one end of each arm coupled to a central core, and the other end of each arm coupled to leaflet-piercing elements, which protrude through the valve leaflets and into the wire mesh of the support.

There is therefore provided, in accordance with an application of the present invention, apparatus for use with a heart valve of a patient, the heart valve including at least two leaflets, the apparatus including:

a support, having a leaflet-engaging side, configured to be placed against a first side of the heart valve in a position in which respective portions of the leaflet-engaging side of the support are disposed against respective regions of respective leaflets of the valve; and

a plurality of leaflet-piercing elements, deliverable to a second side of the heart valve of the patient, and configured to couple the support to the heart valve by (1) piercing the leaflets of the heart valve from the second side of the heart valve to the first side of the heart valve, and (2) coupling to the support while the support is in the position on the first side of the heart valve.

In an application, the support is flat.

In an application, the support is disc-shaped.

In an application, the support has a delivery configuration in which the support is generally cylindrical, and a deployed configuration in which the support is generally flat.

In an application, the support includes a braided wire mesh.

In an application, the leaflet-piercing elements include straight spikes.

In an application, the leaflet-piercing elements include barbs.

In an application, the leaflet-piercing elements include hooks.

In an application, the leaflet-piercing elements are configured to couple to the support by being configured to protrude into the support.

In an application, the leaflet-piercing elements are configured to couple to the support by being configured to protrude through the support.

In an application, the support is transluminally deliverable to the first side of the heart valve of the patient.

In an application, the leaflet-piercing elements are transluminally deliverable to the second side of the heart valve independently of the support.

In an application, the apparatus further includes a securing element, including:

a core;

two or more arms, an inner end of each arm being coupled to the core, and the arms extending radially outward from the core; and

the leaflet-piercing elements, coupled to respective outer ends of each arm.

In an application, the securing element is transluminally deliverable to the second side of the heart valve independently of the support.

In an application, the apparatus is configured such that the leaflet-engaging elements are configured to be coupled to the support by the securing element being configured to be coupled to the support.

In an application, the apparatus is configured such that coupling the leaflet-engaging elements to the support while the support is in the position on the first side of the heart valve, sandwiches the leaflets of the heart valve between the support and the securing element.

In an application, the core defines a coupling portion, configured to couple the core to the support.

In an application, the apparatus is configured such that the coupling of the core to the support facilitates the coupling of the leaflet-piercing elements to the support.

In an application, the support defines an inner perimeter that defines an opening through the support, and the coupling portion is configured to couple the core to the support, by being configured to secure at least part of the coupling portion within the opening.

In an application, the core is configured to extend between the leaflets of the heart valve, from the second side of the heart valve to the first side of the heart valve, such that the coupling portion is couplable to the support at the first side of the heart valve.

In an application, the securing element has a delivery configuration and a deployed configuration, and the outer end of the arms are closer to each other in the delivery configuration than in the deployed configuration.

In an application:

the securing element is disposable within a sheath, and is removable from the sheath,

the delivery configuration defines a constrained configuration, the sheath being configured to constrain the securing element in the constrained delivery configuration,

the deployed configuration defines an unconstrained configuration, and

the securing element is configured to automatically move from the delivery configuration to the deployed configuration when the securing element is removed from the sheath.

There is further provided, in accordance with an application of the present invention, a method for use with a heart valve of a patient, the heart valve including at least two leaflets, the method including:

delivering, to a first side of the heart valve, a support, having a leaflet-engaging side;

delivering, to a second side of the heart valve, a plurality of leaflet-piercing elements;

piercing the leaflets of the valve, from the second side to the first side of the valve, with the leaflet-piercing elements; and

coupling the support to the leaflets, such that respective portions of the leaflet-engaging side of the support are disposed against respective regions of respective leaflets, by coupling, at the first side of the valve, the leaflet-piercing elements to the support.

In an application, delivering the support includes delivering a flat support.

In an application, delivering the support includes delivering a disc-shaped support.

In an application, delivering the support includes delivering a support that includes a braided wire mesh.

In an application, delivering the support includes:

percutaneously delivering the support while the support is in a generally-cylindrical delivery configuration thereof, and

subsequently, deploying the support into a generally flat deployed configuration thereof.

In an application, coupling the leaflet-piercing elements to the support includes advancing the leaflet-piercing elements into the support.

In an application, coupling the leaflet-piercing elements to the support includes advancing the leaflet-piercing elements through the support.

In an application, delivering the leaflet-piercing elements includes delivering the leaflet-piercing elements independently of delivering the support.

In an application, delivering the leaflet-piercing elements includes delivering, to the second side of the valve, a securing element that includes (1) a core, (2) two or more arms, an inner end of each arm being coupled to the core, and the arms extending radially outward from the core, and (3) the leaflet-piercing elements, coupled to respective outer ends of each arm.

In an application, coupling the leaflet-piercing elements to the support includes coupling the securing element to the support.

In an application, coupling the securing element to the support includes sandwiching the leaflets between the securing element and the support.

In an application, coupling the securing element to the support includes coupling the core to the support, and coupling the core to the support facilitates coupling the leaflet-piercing elements to the support.

In an application, the core defines a coupling portion, and coupling the securing element to the support includes coupling the coupling portion of the core to the support.

In an application, coupling the coupling portion to the support facilitates the coupling of the leaflet-piercing elements to the support.

In an application, the support defines an inner perimeter that defines an opening through the support, and coupling the coupling portion of the core to the support includes securing at least part of the coupling portion within the opening.

In an application, coupling the coupling portion of the core to the support, includes coupling the coupling portion to the support at the first side of the heart valve.

In an application, coupling the coupling portion to the support includes moving at least part of the coupling portion, from the second side of the heart valve, between the leaflets of the heart valve, to the first side of the heart valve.

There is further provided, in accordance with an application of the present invention, apparatus for use with one or more sutures, the apparatus including:

a first tubular element, shaped to define a first lumen therethrough, and having a first end and a second end; and

a second tubular element, shaped to define a second lumen therethrough, and having a first end and a second end,

the apparatus having:

• • an unlocked configuration in which:
    • the first end of the second tubular element is disposed closer to the first end of the first tubular element than is the second end of the second tubular element, and
    • the sutures are disposable within and slidable through the first and second lumens, and a locking configuration in which:
    • the second end of the second tubular element is disposed closer to the first end of the first tubular element than is the first end of the second tubular element, and
    • the sutures are inhibited from sliding through the first and second lumens.

In an application, the second tubular element has a length, from the first end of the second tubular element to the second end of the second tubular element, that is smaller than the cross-sectional diameter of the first lumen.

In an application, the sutures include a first suture and a second suture, and the apparatus having a locking configuration in which the sutures are inhibited from sliding through the first and second lumens, includes the apparatus having a locking configuration in which the first suture is inhibited from moving with respect to the second suture.

In an application, the apparatus is configured such that:

in the unlocked configuration, the second end of the second tubular element is disposed outside of the first lumen, and

in the locking configuration, the second end of the second tubular element is disposed within the first lumen.

In an application, the second end of the first tubular element is coupled to the first end of the second tubular element.

In an application, the apparatus is configured such that, when the sutures are disposed within the lumens of the first and second tubular elements, movement of the apparatus from the unlocked to the locking configuration rotates at least a portion of each suture.

In an application, the apparatus is configured such that movement of the apparatus from the unlocked to the locking configuration rotates the second tubular element.

In an application, the first and second tubular elements include a continuous piece of material.

In an application, the first tubular element is shaped such that the first lumen has a cross-sectional diameter that is greater than a cross-sectional diameter of the second lumen.

In an application, the first tubular element is shaped such that the first lumen has a cross-sectional diameter that is more than 1.1 times greater than the cross-sectional diameter of the second lumen.

In an application, the first tubular element is shaped such that the first lumen has a cross-sectional diameter that is less than 1.5 times greater than the cross-sectional diameter of the second lumen.

In an application:

the unlocked configuration includes a constrained configuration, and the locking configuration includes an unconstrained configuration, and

the apparatus is configured to be retained in the constrained unlocked configuration by a constraining force, and to automatically move toward the unconstrained locking configuration when the constraining force is removed.

In an application, the apparatus further includes a constraint, configured to provide the constraining force.

In an application, the constraint includes a rod, disposable in the lumen of at least one of the tubular elements, configured to provide the constraining force by being disposed in the lumen, the constraining force being removable by removing the rod from the lumen.

In an application, the constraint includes a constraining sheath, configured to provide the constraining force by being disposed around at least one of the tubular members, the constraining force being removable by removing the sheath from the at least one of the tubular members.

In an application, the first and second tubular elements both define respective inner and outer surfaces, and, in the locking configuration, at least part of the outer surface of the second tubular element is disposed against at least part of the inner surface of the first tubular element.

In an application, the apparatus is configured such that, when the sutures are disposed within the lumens of the first and second tubular elements, movement of the apparatus from the unlocked to the locking configuration sandwiches at least a portion of each suture between the outer surface of the second tubular element and the inner surface of the first tubular element.

In an application, the apparatus includes at least one helical element.

In an application, at least in the unlocked configuration, the apparatus defines a continuous helix from the first end of the first tubular element to the second end of the second tubular element.

In an application, the first tubular element includes a first helical element and the second tubular element includes a second helical element.

In an application, the second end of the first tubular element is coupled to the first end of the second tubular element by a connecting portion.

In an application, the tubular elements and the connecting portion include a continuous piece of material.

There is further provided, in accordance with an application of the present invention, apparatus for use with one or more sutures, the apparatus including:

a first tubular element, shaped to define a first lumen therethrough, and having a proximal end and a distal end; and

a second tubular element, shaped to define a second lumen therethrough, and having a first end and a second end,

the apparatus having:

• • an unlocked configuration in which:
    • the second end of the second tubular element is disposed distally to the first end of the second tubular element, and
    • the sutures are disposable within and slidable through the first and second lumens, and a locking configuration in which:
    • the first end of the second tubular element is disposed distally to the second end of the second tubular element, and
    • the sutures are inhibited from sliding through the first and second lumens.

In an application, the apparatus is configured such that:

in the unlocked configuration, the second end of the second tubular element is disposed outside of the first lumen, and

in the locking configuration, the second end of the second tubular element is disposed within the first lumen.

In an application, the apparatus is configured such that, when the sutures are disposed within the lumens of the first and second tubular elements, movement of the apparatus from the unlocked to the locking configuration rotates at least a portion of each suture.

In an application, the first and second tubular elements both define respective inner and outer surfaces, and, in the locking configuration, at least part of the outer surface of the second tubular element is disposed against at least part of the inner surface of the first tubular element.

In an application, the apparatus is configured such that, when the sutures are disposed within the lumens of the first and second tubular elements, movement of the apparatus from the unlocked to the locking configuration sandwiches at least a portion of each suture between the outer surface of the second tubular element and the inner surface of the first tubular element.

There is further provided, in accordance with an application of the present invention, apparatus for use with one or more sutures, the apparatus including:

a first tubular element, shaped to define a first lumen therethrough; and

a second tubular element, coupled to the first tubular element, and shaped to define a second lumen therethrough,

the apparatus having:

• • an unlocked configuration in which at least a quarter of the second tubular element is disposed outside of the first lumen, and the sutures are disposable within and slidable through the first and second lumens, and
  • a locking configuration in which at least a quarter of the second tubular element is disposed inside the first lumen, and the sutures are inhibited from sliding through the first and second lumens, and

the apparatus being constrainable in the unlocked configuration by a removable constraining force, and configured to automatically move toward the second configuration when the constraining force is removed.

In an application, the apparatus is configured such that, when the sutures are disposed within the lumens of the first and second tubular elements, movement of the apparatus from the unlocked to the locking configuration rotates at least a portion of each suture.

In an application, the first and second tubular elements both define respective inner and outer surfaces, and, in the locking configuration, at least part of the outer surface of the second tubular element is disposed against at least part of the inner surface of the first tubular element.

In an application, the apparatus is configured such that, when the sutures are disposed within the lumens of the first and second tubular elements, movement of the apparatus from the unlocked to the locking configuration sandwiches at least a portion of each suture between the outer surface of the second tubular element and the inner surface of the first tubular element.

There is further provided, in accordance with an application of the present invention, apparatus for use with one or more sutures, the apparatus including:

a first tubular element, shaped to define a first lumen therethrough; and

a second tubular element shaped to define a second lumen therethrough, the second tubular element being coupled to the first tubular element at a coupling point, the coupling point being configured to facilitate deflection of the second tubular element around the coupling point, and

the apparatus:

• • having an unlocked configuration in which the sutures are disposable within and slidable though the first and second lumens, and a locking configuration in which the sutures are inhibited from sliding through the first and second lumens,
  • being configured to be constrainable in the unlocked configuration by a constraining force, and
  • being configured, when the constraining force is removed, to automatically move from the unlocked configuration to the locking configuration, by the second tubular element deflecting around the coupling point.

In an application, the apparatus is configured such that, when the sutures are disposed within the lumens of the first and second tubular elements, the deflecting of the second tubular element around the coupling point rotates at least a portion of each suture.

In an application, the first and second tubular elements both define respective inner and outer surfaces, and, in the locking configuration, at least part of the outer surface of the second tubular element is disposed against at least part of the inner surface of the first tubular element.

In an application, the apparatus is configured such that, when the sutures are disposed within the lumens of the first and second tubular elements, the deflecting of the second tubular element around the coupling point sandwiches at least a portion of each suture between the outer surface of the second tubular element and the inner surface of the first tubular element.

There is further provided, in accordance with an application of the present invention, apparatus for use with one or more sutures, the apparatus including:

a casing, shaped to define a cavity, and one or more openings in which the sutures are disposable;

a core, disposed in the cavity, and shaped to define a lumen in which the sutures are disposable,

the apparatus:

• • having an unlocked configuration in which the sutures are disposable within and slidable through the openings and the lumen, and a locking configuration in which the sutures are inhibited from sliding through the openings and the lumen,
  • being movable from the unlocked configuration to the locking configuration, and
  • being configured such that, when the sutures are disposed within the openings and the lumen, and the apparatus moves from the unlocked configuration to the locking configuration, the apparatus (1) cuts the sutures at a cutting site of the apparatus, and (2) becomes coupled to the sutures at a coupling site of the apparatus.

In an application:

the casing defines two or more openings, the openings being provided along a longitudinal axis of the casing,

in the unlocked configuration of the apparatus, the lumen of the core is disposed along the axis, and between the openings, and

in the locking configuration of the apparatus, the core is disposed with respect to the casing in a manner in which the lumen of the core is not disposed along the axis.

In an application:

the casing defines two or more openings,

in the unlocked configuration of the apparatus, the lumen of the core is generally in fluid communication with the openings, and

in the locking configuration of the apparatus, the lumen of the core is generally not in fluid communication with the openings.

In an application:

the unlocked configuration includes a constrained configuration, and the locking configuration includes an unconstrained configuration, and

the apparatus is configured to be retained in the constrained unlocked configuration by a constraining force, and to automatically move toward the unconstrained locking configuration when the constraining force is removed.

In an application, the apparatus further includes a constraint, configured to provide the constraining force.

In an application, the constraint includes a constraining sheath.

In an application, the cutting site includes at least one cutting edge, and the apparatus is configured to cut the sutures by pushing the sutures against the cutting edge.

In an application:

the at least one cutting edge includes first and second cutting edges,

the casing is shaped to define the first cutting edge, and the core is shaped to define the second cutting edge,

delivering, to a vicinity of the anatomical site, apparatus that includes (1) a first tubular element, shaped to define a first lumen therethrough, and having a first end and a second end, and (2) a second tubular element, shaped to define a second lumen therethrough, and having a first end and a second end;

sliding the apparatus over at least part of the sutures while the apparatus is in an unlocked configuration thereof in which (1) the first end of the second tubular element is disposed closer to the first end of the first tubular element than is the second end of the second tubular element, and (2) the sutures are slidable through the first and second lumens; and

securing the apparatus to the sutures by moving the apparatus into a locking configuration thereof in which: (1) the second end of the second tubular element is disposed closer to the first end of the first tubular element than is the first end of the second tubular element, and (2) the sutures are inhibited from sliding through the first and second lumens.

There is further provided, in accordance with an application of the present invention, a method for use with one or more sutures at an anatomical site of a patient, the method including: delivering, to a vicinity of the anatomical site, apparatus that includes (1) a first tubular element, shaped to define a first lumen therethrough, and having a first end and a second end, and (2) a second tubular element, shaped to define a second lumen therethrough, and having a first end and a second end;

sliding the apparatus over at least part of the sutures while the apparatus is in an unlocked configuration thereof in which (1) the first end of the second tubular element is disposed closer to the first end of the first tubular element than is the second end of the second tubular element, and (2) the sutures are slidable through the first and second lumens; and

subsequently inhibiting the sutures from sliding through the first and second lumens by moving the apparatus into a locking configuration in which the second end of the second tubular element is disposed closer to the first end of the first tubular element than is the first end of the second tubular element.

In an application, in the unlocked configuration, the second end of the second tubular element of the apparatus is disposed outside of the first lumen, and moving the apparatus into the locking configuration includes moving the second end of the second tubular element into the first lumen.

In an application, moving the apparatus into the locking configuration includes moving at least a quarter of the second tubular element into the first lumen.

In an application, moving the apparatus into the locking configuration includes sandwiching at least a portion of each suture between an outer surface of the second tubular element and an inner surface of the first tubular element.

In an application, the apparatus is configured to be constrained in the unlocked configuration by a constraining force, and moving the apparatus into the locking configuration includes removing the constraining force.

In an application, removing the constraining force includes removing, from the lumen of at least one of the tubular elements, a rod that is (1) disposed in the lumen of the least one of the tubular elements, and (2) configured to provide the constraining force.

In an application, removing the constraining force includes removing, from around at least one of the tubular elements, a constraining sheath that is (1) disposed around the at least one of the tubular elements, and (2) configured to provide the constraining force.

In an application, moving the apparatus into the locking configuration includes rotating the second tubular element.

In an application, the first tubular element is coupled to the second tubular element via a coupling point, and rotating the second tubular element includes deflecting the second tubular element around the coupling point.

There is further provided, in accordance with an application of the present invention, a method for use with one or more sutures at an anatomical site of a patient, the method including:

delivering, to a vicinity of the anatomical site, apparatus that includes (1) a casing, shaped to define a cavity, and one or more openings in which the sutures are disposable, and (2) a core, disposed in the cavity, and shaped to define a lumen in which the sutures are disposable;

sliding the apparatus over at least part of the sutures while the apparatus is in an unlocked configuration thereof, in which the sutures are slidable through the openings and the lumen; and

subsequently, by moving the apparatus into a locking configuration thereof, simultaneously (1) inhibiting the sutures from sliding through the lumen by coupling the apparatus to the sutures at a coupling site of the apparatus, and (2) cutting the sutures with one or more cutting edges at a cutting site of the apparatus.

In an application, the apparatus is configured to be constrained in the unlocked configuration by a constraining force, and moving the apparatus into the locking configuration includes removing the constraining force.

In an application, removing the constraining force includes removing, from around at least part of the core, a constraining sheath that is (1) disposed around the at least part of the core, and (2) configured to provide the constraining force.

For some applications, techniques described herein are practiced in combination with techniques described in one or more of the references cited in the Background section and Cross-references section of the present patent application.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A-B and2A-B are schematic illustrations of apparatus comprising a suture-securing device, in accordance with some applications of the invention;

FIGS. 3-7 are schematic illustrations of steps in the use of the apparatus ofFIGS. 1A-B and2A-B to repair a cardiac valve, in accordance with some applications of the invention;

FIGS. 8A-B and9A-B are schematic illustrations of a suture-securing device, in accordance with some applications of the invention;

FIG. 10 is a schematic illustration of the suture-securing device ofFIGS. 8A-B and9A-B, having been used to repair a cardiac valve, in accordance with some applications of the invention;

FIGS. 11A-B are schematic illustrations of apparatus for repairing a heart valve, in accordance with some applications of the invention;

FIGS. 12A-F,13A-B and14 are schematic illustrations of the use of the apparatus ofFIGS. 11A-B to repair a heart valve, in accordance with some applications of the invention; and

FIG. 15 is a schematic illustration of the apparatus ofFIGS. 11A-B having been used to repair a heart valve, in accordance with some applications of the invention.

DETAILED DESCRIPTION OF EMBODIMENTS

Reference is made toFIGS. 1A-B and2A-B, which are schematic illustrations ofapparatus20, comprising a suture-securingdevice22, in accordance with some applications of the invention.Device22 has an unlocked configuration in which one or more sutures are generally slidable through the device, and a locking configuration in which the sutures are generally not slidable through the device, and is movable from the unlocked configuration to the locking configuration.

FIGS. 1A-B show device22 in the unlocked configuration thereof.FIG. 1A shows a side view ofdevice22 being used with twosutures34aand34b, andFIG. 1B shows a cutaway view of the same. It is to be noted that, althoughdevice22 is shown being used with two individual sutures, the device may be used with two portions of the same suture (e.g., the suture is looped), and/or with more or fewer sutures (e.g., to secure the device and/or an element coupled thereto, to a particular point on a single suture). It is to be further noted that, althoughsutures34aand34bare shown as ribbon-like sutures (e.g., having a generally rectangular cross-section), any suitable type of suture, as is known in the art, may be used.

Device22 comprises a firsttubular element24, which is shaped to define a first lumen L1, afirst end10 and asecond end11, and a secondtubular element26, which is shaped to define a second lumen, afirst end12 and asecond end13. Typically, secondtubular element26 is narrower than firsttubular element24. That is, lumen L2 typically has a smaller transverse cross-sectional area than does lumen L1. Typically, the second tubular element has an outer edge that has a diameter D2 that is smaller than a diameter D1 of an inner edge of the first tubular element.

For some applications of the invention, diameter D1 is more than 1.1 times greater and/or less than 1.5 times greater than diameter D2. Typically, secondtubular element26 has a longitudinal length (i.e., fromfirst end12 to second end13) that is smaller than diameter D1 of firsttubular element24, e.g., so as to facilitate rotation of the second tubular element within lumen L1 of the first tubular element.

Typically,device22 is used in catheter-based procedures or minimally-invasive procedures, and is positioned with respect to the operating physician such that secondtubular element26 is distal to firsttubular element24. Alternatively, the device is positioned with respect to the physician such that the first tubular element is distal to the second tubular element. For some applications,device22 may be used in a surgical procedure, e.g., an open-heart procedure.

In the unlocked configuration ofdevice22, the first and second tubular elements are typically disposed end to end.

That is, in the unlocked configuration ofdevice22, one or more of the following are typically true:

(1)first end12 of the second tubular element is disposed closer tofirst end10 of the first tubular element than issecond end13 of the second tubular element,

(2)second end13 of the second tubular element is disposed distally (i.e., with respect to the operating physician) tofirst end12 of the second tubular element, and

(3) at least a quarter (e.g., all) of secondtubular element26 is disposed outside of lumen L1 of the first tubular element.

In the unlocked configuration, sutures34aand34bare slidable throughdevice22, i.e., through lumens L1 and L2 oftubular elements24 and26. That is, in the unlocked configuration, the device is slidably coupled to the sutures, i.e., is slidable over the sutures. Typically,device22 is delivered to an anatomical site (e.g., in a vicinity of a site being treated) withsutures34aand34bpre-threaded through the device.

Typically, and as shown inFIGS. 1A-B,device22 comprises at least one helical element, e.g., a coil. For example, and as shown inFIGS. 1A-B,tubular elements24 and26 may be defined by at least one helix. Further typically,device22 comprises a continuous piece of material. For example,device22 may be fabricated from a single elongate piece of material, such as a wire, that has been shaped to definetubular elements24 and26 (e.g., by being shaped to define a first helix that definestubular element24, and a second helix that defines tubular element26). Typically, the material comprises a metal such as, but not limited to, stainless steel, titanium, nickel titanium (Nitinol), nickel cobalt, and/or cobalt chrome. For some applications, the material comprises a polymer and/or a resin. Further typically, and as described hereinbelow with reference toFIGS. 2A-B, the material comprises a shape-memory material.

Helical elements24 and26 are typically coupled by a connectingportion38, which facilitates movement ofdevice22 from the unlocked configuration to the locking configuration. For some applications in whichtubular elements24 and26 are defined by helices and comprise a single piece of material, connectingportion38 also comprises the single piece of material. That is, for such applications,device22, comprising connectingportion38, comprises a single piece of material.

FIGS. 2A-B show device22 in the locking configuration thereof, i.e., after having moved into the locking configuration.FIG. 2A shows a side view ofdevice22 being used with twosutures34aand34b, andFIG. 2B shows a cutaway view of the same. In the locking configuration ofdevice22, secondtubular element26 is oriented at about 180 degrees compared to its position in the unlocked configuration of the device. That is, whendevice22 moved from the unlocked to the locking configuration, the second tubular element rotates and/or is deflected around an axis that is generally orthogonal to a longitudinal axis fromfirst end10 of the first tubular element tosecond end13 of the second tubular element. Typically, and as shown inFIGS. 2A-B, secondtubular element26 is deflected around connectingportion38.

Typically, in the locking configuration ofdevice22, one or more of the following are true:

(1)second end13 of the second tubular element is disposed closer tofirst end10 of the first tubular element than isfirst end12 of the second tubular element,

(2)first end12 of the second tubular element is disposed distally (i.e., with respect to the operating physician) tosecond end13 of the second tubular element, and

(3) at least a quarter of secondtubular element26 is disposed inside lumen L1 of the first tubular element.

In the locking configuration, sutures34aand34bare generally not slidable throughdevice22, i.e., through lumens L1 and L2 oftubular elements24 and26. That is, in the locking configuration, the device is fixedly coupled to the sutures, i.e., is generally not slidable over the sutures. Typically, the device is fixedly coupled to the sutures by sandwiching at least part of the sutures between the two tubular elements, e.g., between the outer edge of secondtubular element26 and the inner edge firsttubular element24, as shown atcoupling zone31 inFIG. 2B.

As described hereinabove, device22 (i.e., the tubular elements and coupling portion thereof) typically comprises a single piece of material that has been fabricated into at least one helix. Typically,device22 comprises a shape-memory material, which is configured to be biased (e.g., is shape-set) such that the device moves toward the locking configuration thereof. For such applications, the device is retained in the unlocked configuration by at least one constraint28 (seeFIGS. 1A-B), which provides a constraining force. That is, the locking configuration is an unconstrained locking configuration, and the unlocked configuration is a constrained unlocked configuration.

For some applications, and as shown inFIGS. 1A-B, the constraint comprises arod30, and the constraining force is provided by the distal end of the rod being disposed in lumen L2 of secondtubular element26. So as to movedevice22 into the locking configuration (e.g., so as to fixedly couple the device to the sutures), the surgeon removes the constraining force, e.g., by removing the constraint, such as by withdrawingrod30 from at least lumen L2, such that the device automatically moves to the locking configuration.

For applications of the invention in whichdevice22 is constrained in the unlocked configuration byrod30,rod30 is typically shaped to define a lumen, and the sutures are slidable through the device by being slidable through the lumen of the rod.

For some applications,device22 is constrained in the unlocked configuration by a constraining sheath (not shown) for delivery to an intracorporeal site. At, or in the vicinity of, the intracorporeal site, the device is exposed from the delivery sheath and automatically moves into the locking configuration.

Reference is made toFIGS. 3-7, which are schematic illustrations showing the use ofapparatus20 to treat a condition (e.g., regurgitation or leaflet prolapse) of a cardiac valve4 of aheart2 of a patient, in accordance with some applications of the invention.FIGS. 3-7 show valve4, comprising atricuspid valve94, being treated via aninferior vena cava3 of the patient (e.g., transfemorally). However, the scope of the invention includes the treatment of other heart valves and the use of other access routes, mutatis mutandis. In brief (1) distal ends ofsutures34aand34bare coupled to two sites onannulus5 of valve4, (2) the sutures are placed under tension with respect to each other so as to draw the sites on the annulus toward each other, (3) apparatus is used to secure the sutures in the under-tension configuration, and (4) the sutures are cut and released, so as to leave the sutures under tension and the valve in the drawn-together configuration.

FIG. 3 shows acatheter46 having been advanced through the inferior vena cava and into theright atrium7 of the heart of the patient. Viacatheter46, a firsthelical anchor40a, coupled to a distal end ofsuture34ais coupled to (i.e., screwed into) afirst site6 onannulus5. Typically, anchor40ais delivered via a first inner sheath44a. Subsequently, and as shown inFIG. 4, a secondhelical anchor40b, coupled to a distal end ofsuture34bis coupled to asecond site8 onannulus5. Typically,second site8 is at least 1 cm fromfirst site6, such as a quarter of the way aroundannulus5 from the first site, such as on the opposite side of the annulus to the first site.

For some applications in which cardiac valve4 comprisestricuspid valve94,first site6 is typically in a vicinity of an anterior-posterior commissure (APC)88 (i.e., the commissure betweenanterior leaflet82 and posterior leaflet84) of the valve, andsecond site8 is in a vicinity ofseptal leaflet86 of the valve.

Typically,anchor40bis delivered via a secondinner sheath44b. Alternatively, anchors40aand40bare delivered via the same inner sheath.

FIG. 5shows apparatus20, comprising suture-securingdevice22, having been advanced throughcatheter46. For some applications, and as shown inFIG. 5,device22 is delivered via anouter sheath48.Device22 is typically delivered in the unlocked configuration thereof, and is typically constrained in the unlocked configuration byrod30, as described hereinabove.Rod30 anddevice22 are slid over at least part ofsutures34aand34b. For example, the sutures and helical anchors may be delivered via the lumen of rod30 (e.g.,inner sheaths44aand44bmay be advanced through the lumen of rod30).

FIG. 6 showssutures34aand34bhaving been placed under tension at least with respect to each other, e.g., by pulling respective proximal ends of the sutures proximally and/or by pushingdevice22 distally, such as by using acontroller50. The tension draws together anchors40aand40b, and thereby draws togethersites6 and8. Thereby, the annulus of valve4 is reshaped, so as to treat valve prolapse. This reshaping is typically monitored in real-time (e.g., using ultrasound techniques) so that the operating physician may determine when acceptable reshaping has been achieved.

Reference is now made toFIG. 7. Once the operating physician determines that acceptable reshaping has been achieved,device22 is moved into the locking configuration, e.g., by withdrawingrod30 proximally. Typically, sutures34aand34bare subsequently released, e.g., by being cut at a proximal side ofdevice22.Rod30 and the sheaths and catheter are subsequently removed from the body of the patient.

Reference is made toFIGS. 8A-B and9A-B, which are schematic illustrations of a suture-securingdevice60, in accordance with some applications of the invention.Device60 has an unlocked configuration in which one or more sutures are generally slidable through the device, and a locking configuration in which the sutures are generally not slidable through the device, and is movable from the unlocked configuration to the locking configuration.

FIGS. 8A-B show device60 in the unlocked configuration thereof.FIG. 8A shows a perspective view ofdevice60 being used with twosutures34aand34b, andFIG. 8B shows a cutaway view of the same.FIG. 8A further shows an exploded view ofdevice60. It is to be noted that, althoughdevice60 is shown being used with two individual sutures, the device may be used with two portions of the same suture (e.g., the suture is looped), and/or with more or fewer sutures (e.g., to secure the device and/or an element coupled thereto, to a particular point on a single suture).

Device60 comprises acasing62, shaped to define acavity63 and one ormore openings64, and acore66, disposed incavity63, and shaped to define a lumen L3 therethrough. Typically, casing62 defines twoopenings64. Typically,cavity63 is open at a lateral side of the casing.Core66 is movable, at least in part, withincavity63. Typically, apin70 is disposed throughcasing62 andcore66, such thatcore66 is movable withincavity63 without decoupling from casing62. For example, and as shown inFIGS. 8A-9B,core66 may be shaped to define asocket74 that has a transverse cross-sectional shape that is larger than a transverse cross-sectional shape ofpin70.Pin70 is fixedly coupled to casing62 and movably-coupled, viasocket74, tocore66. Due to the difference in size between the respective cross-sectional shapes ofpin70 andsocket74,core66 is movable withincavity63 without decoupling from casing62.

In the unlocked configuration ofdevice60, lumen L3 is typically aligned betweenopenings64, i.e., the lumen is typically disposed on an axis between the openings. Typically, thereby, in the unlocked configuration, lumen L3 is generally in fluid communication withopenings64.

In the unlocked configuration, sutures34aand34bare slidable throughdevice60, i.e., throughopenings64 and lumen L3. That is, in the unlocked configuration, the device is slidably coupled to the sutures, i.e., is slidable over the sutures. Typically,device60 is delivered to an anatomical site (e.g., in a vicinity of a site being treated) withsutures34aand34bpre-threaded through the device.

Device60 typically further comprises and/or defines one or more cutting edges, such as cuttingedges80aand80b, described further with reference toFIGS. 9A-B.

FIGS. 9A-B show device60 in the locking configuration thereof, i.e., after having moved into the locking configuration.FIG. 9A shows a perspective view ofdevice60 being used with twosutures34aand34b, andFIG. 9B shows a cutaway view of the same. In the locking configuration ofdevice60, lumen L3 is typically not aligned betweenopenings64, i.e., the lumen is typically not disposed on an axis between the openings. Typically, thereby, in the locking configuration, lumen L3 is generally not in fluid communication withopenings64.

In the locking configuration, sutures34aand34bare generally not slidable throughdevice60, i.e., throughopenings64 and lumen L3. That is, in the locking configuration, the device is fixedly coupled to the sutures, i.e., is generally not slidable over the sutures. Typically, the device is fixedly coupled to the sutures by sandwiching at least part of the sutures betweencore66 andcasing62, as shown atcoupling zone61 inFIG. 9B.

Whendevice60 moves into the locking configuration, the device cuts the sutures disposed therein, at a cuttingzone65. Typically, afirst cutting edge80ais defined by casing62, asecond cutting edge80bis defined bycore66, and whensutures34aand34bare slid throughdevice60, part of each suture is disposed between the two cutting edges. Whendevice60 moves into the locking configuration, the two cutting edges move toward and, typically, past each other, thereby cutting the sutures.

A portion of each suture typically remains withindevice60 subsequent to the fixed-coupling of the device to the sutures. For example, and as shown inFIG. 9B,coupling zone61 may be disposed close to one end of device60 (e.g., in a vicinity of one opening64), and cuttingzone65 may be disposed close to another end of the device (e.g., in a vicinity of the other opening64).

Device60 is typically configured to be biased such that the device moves toward the locking configuration thereof. Typically,device60 is thus configured by comprising at least onespring72, which movescore66 with respect tocasing62. For such applications, the device is retained in the unlocked configuration by at least one constraint, which provides a constraining force. That is, the locking configuration is an unconstrained locking configuration, and the unlocked configuration is a constrained unlocked configuration.

For example, a portion ofcore66 may protrude from a lateral surface ofcasing62 when the device is in the locking configuration, and the constraint may comprise a delivery sheath (not shown), which inhibits that portion ofcore66 from protruding thus. So as to movedevice60 into the locking configuration (e.g., so as to fixedly couple the device to the sutures, and to cut the sutures), the operating physician removes the constraining force, e.g., by removing the constraint, such as by withdrawing the sheath, such that the device automatically moves to the locking configuration.

Reference is made toFIG. 10, which is a schematicillustration showing device60 having been used to treat prolapse in cardiac valve4, in accordance with some applications of the invention. Typically,device60 is used in combination with the techniques described with reference toFIGS. 3-7, mutatis mutandis.FIG. 10 shows sutures34aand34bhaving been (1) coupled toannulus5 atsites6 and8, usinghelical anchors40aand40b, (2) fixedly coupled toapparatus60 and, thereby to each other, and (3)cut using apparatus60.

Reference is made toFIGS. 11A-14, which are schematic illustrations of asystem100 for repairing heart valve4, and steps in the use of the system for repairing the heart valve, in accordance with some applications of the invention.System100 comprises asupport102 and a plurality of leaflet-piercingelements106, configured to couple the support to the heart valve by piercing the leaflets of the heart valve and coupling to the support. Typically, leaflet-piercingelements106 are deliverable to the valve independently ofsupport102.

Typically,system100 comprises a securingelement104, which compriseselements106. Securingelement104 typically further comprises acore108 and a plurality ofarms110. A respective inner end of eacharm110 is coupled tocore108, from which the arms extend radially.Elements106 are coupled to respective outer ends of each arm. Typically, securingelement104 is deliverable to the valve independently ofsupport102.

Coupling of securingelement104 to support102 is facilitated by leaflet-piercingelements106. Typically,support102 has aninner perimeter114 that defines anopening115, and coupling of securingelement104 to support102 is further facilitated by at least part ofcore108 ofelement104 being disposed withinopening115. Typically,core108 is shaped to define acoupling portion109, which secures the core within the opening. For example,coupling portion109 may comprise, or be shaped to define, aridge111 which inhibits the core from being decoupled from opening115 (e.g.,coupling portion109locks core108 to support102).

FIG. 11A showssupport102 and securingelement104 individually, andFIG. 11B shows the securing element coupled to the support.

Typically,support102 comprises abraided wire mesh112, which, when unconstrained, has an expanded configuration, and can be compressed into a compressed configuration. Typically,support102 is compressed into the compressed configuration for delivery to the heart valve, is constrained in the compressed configuration by a catheter via which the support is delivered, and automatically expands upon being released from a distal end of the catheter at the heart valve. Typically, in the compressed configuration, the support is generally cylindrical in shape. In the uncompressed configuration,support102 defines a leaflet-engaging side118 (typically a downstream side of the support) that is typically a flat side. In the uncompressed configuration,support102 itself is typically flat. Further typically, in the uncompressed configuration, the support defines two adjacent layers and is generally circular (i.e., disc-shaped).

Typically, securingelement104 has a delivery configuration in whicharms110 are disposed distally tocore108, and is configured to be movable to a deployed configuration following delivery to the heart valve. Typically,element104 is configured to be constrained in the delivery configuration by a delivery sheath, and to automatically move toward the deployed configuration upon being exposed from the sheath at the heart valve.

FIGS. 11A-14show apparatus100, and its use in treatingtricuspid valve94 viainferior vena cava3 of the patient. However, the scope of the invention includes the treatment of other heart valves and the use of other access routes, mutatis mutandis. Additionally, securingelement104 is shown comprising 6 arms and leaflet-piercing elements, but may comprise other pluralities of arms and leaflet-piercing elements.

FIGS. 12A-F show steps in the use ofapparatus100 to treat (e.g., to repair) valve4, in accordance with some applications of the invention. Acatheter120 is advanced to the valve; typically toright atrium7 via inferior pulmonary artery3 (e.g., transfemorally), as shown inFIG. 12A.FIG. 12B shows adelivery sheath122 having been advanced out of a distal end ofcatheter120 and, via valve4, to a downstream side of the valve (i.e., into right ventricle9) of the patient.FIG. 12B further shows securingelement104 having been moved (e.g., advanced distally) out ofdelivery sheath122 and intoventricle9, and expanding into the deployed configuration.

Subsequently, securingelement104 is moved (e.g., pulled) proximally, such that leaflet-piercingelements106 pierce the leaflets of the valve, thereby coupling the securing element to the leaflets, as shown inFIG. 12C. Securingelement104 is shown comprising six arms and leaflet-piercing elements, and being coupled to the leaflets such that two leaflet-piercing elements pierce (i.e., couple to) each leaflet. It is to be noted that the scope of the present invention includes securingelement104 comprising other pluralities of arms and/or leaflet-piercing elements, and other configurations of coupling to the leaflets.

Subsequently, as shown inFIG. 12D-E,support102 is delivered to an upstream side of the valve (i.e., into right atrium7). Typically,support102 is advanced throughcatheter120 and, upon being exposed from the end of the catheter, automatically expands into its expanded configuration. Typically,delivery sheath122 is typically disposed within opening115 of the support. That is,perimeter114 of the support is disposed arounddelivery sheath122, which is typically still coupled to securingelement104. For some applications,delivery sheath122 is coupled to securingelement104 by a lock124 (seeFIG. 13A), which is controllable from outside of the body of the patient. For some such applications,lock124 is directly coupled todelivery sheath122. Alternatively, lock124 is coupled to a controller (e.g., a control wire; not shown) that is disposed withinsheath122.

Support102 is placed against the leaflets of the valve (e.g., leaflet-engagingside118 of the support is placed against the upstream surface of the leaflets), typically by being slid overdelivery sheath122. That is,delivery sheath122 typically acts as a guide forsupport102.FIG. 12E shows a perspective view, andFIG. 13A shows a respective cutaway view, ofsupport102 disposed against the leaflets. Typically,support102 is placed, and is configured to be placed, against the leaflets of the valve such that the support overlaps more than one leaflet. That is, the support is typically placed such that respective portions of the leaflet-engaging side of the support are disposed against respective regions of respective leaflets of the valve.

FIGS. 12F and 13B show respective perspective and cutaway views ofsupport102 having been fixedly coupled to securingelement104, thereby sandwiching the leaflets of the valve between the support and the securing element. Leaflet-piercingelements106 typically protrude into (e.g., through)support102.FIGS. 12F and 13B also showcatheter120 andsheath122 having been removed from the body of the patient. Typically, this fixed coupling is performed by securingelement104 is held immobile or pulled proximally, whilesupport102 is pushed distally, such thatinner perimeter114 of the support is slid over at least part ofcore108 of the coupling element. For example, the support may be slid overcoupling portion109, such thatridge111 is ‘clicked’ into place. Typically,support102 is pushed distally usingcatheter120 and/or a separate controller (not shown). Ifsupport102 is pushed usingcatheter120, the catheter has an outer diameter that is greater than the diameter of opening115 of the support.

FIG. 13B showsarms110 of securingelement104 as being bent compared to the appearance of the arms inFIG. 13A. For some applications of the invention,arms110 are resilient, and are configured to be bent by the coupling ofelement104 to support102, acting like a spring. This configuration facilitates the coupling ofapparatus100 to the valve leaflets by transferring force from the coupling ofcoupling portion109 andperimeter114, to leaflet-piercingelements106, thereby holding leaflet-piercingelements106 within the leaflets and withinmesh112 ofsupport102. That is, coupling ofcoupling portion109 ofcore108 to the support facilitates coupling of the leaflet-piercing elements to the support. For some applications of the invention, leaflet-piercingelements106 comprise straight spikes. For other applications of the invention, leaflet-piercingelements106 comprise barbs or hooks, so as to facilitate fixed coupling of the leaflet-piercing elements directly tomesh112.

As shown inFIGS. 12F and 13B, whenapparatus100 is implanted (i.e., coupled to the leaflets of the heart valve),arms110 of securingelement104 are typically disposed on one side of the valve, and bothcoupling portion109 and leaflet-piercingelements106 are coupled to support102 on the other side of the valve. Thereby, for some applications, securingelement104 is coupled to support102 only at the upstream side of the heart valve of the patient.

FIGS. 12A-13Bshow securing element104 being moved proximally (i.e., upstream), so as to couple to the valve leaflets, prior to the delivery ofsupport102. However, for some applications of the invention,support102 is delivered before movingelement104 proximally.

FIG. 14 is an atrial-side view ofapparatus100 having been used to repair valve4 (e.g., tricuspid valve94), as described inFIGS. 12A-13B.Support102 is typically coupled to the leaflets of the valve such that the support overlaps more than one leaflet. That is, the support is typically coupled to the valve such that respective regions of the support are disposed against respective portions of respective leaflets of the valve. The cusps of the leaflets of the valve are typically held close to each other (e.g., touching each other) byapparatus100, which is thereby disposed generally centrally in the valve. Typically, portions of the leaflets betweenapparatus100 and the leaflet commissures (e.g., APC88) are not held close to each other, and move with the beating of the heart. That is, these portions of the leaflets typically open during ventricular diastole and close during ventricular systole, thereby forming three orifices which typically act as separate valves.FIG. 14 shows these portions of the leaflets open (i.e., during diastole), such thatright ventricle9 is visible therebetween.

For some applications of the invention,support102 is dimensioned to cover more than 10% and/or less than 90% (e.g., between 10% and 90%, such as between 10% and 30%) of the area defined by the native orifice of the heart valve. For example, a support of desired dimensions may be selected according to the valve and/or patient being treated (e.g., following measurement of the valve being treated).

It is hypothesized that the use ofapparatus100 as described with reference toFIGS. 11-14 reduces heart valve regurgitation, and may be used to repair a diseased heart valve.

Reference is now made toFIG. 15. Althoughapparatus100 is shown hereinabove being configured and used, to repairtricuspid valve94, the apparatus may be configured and used with other heart valves. For example,FIG. 15shows apparatus100 having been used to repair a mitral valve130 of a patient, wherebysupport102 is disposed in aright atrium137 of the patient, and securing element104 (not visible inFIG. 15) is disposed in aright ventricle139 of the patient. For a bicuspid heart valve such as mitral valve130, two orifices are typically formed betweenapparatus100. and the commissures.

Apparatus100 is typically coupled to the heart valve being treated, such thatsupport102 is disposed against an upstream side of the valve (i.e., an upstream side of the valve leaflets), and securingelement104 is disposed against a downstream side of the valve (i.e., against a downstream side of the valve leaflets). However, for some applications,apparatus100 is coupled to the heart valve such thatsupport102 is disposed against the downstream side of the valve, and securingelement104 is disposed against the upstream side of the valve.

Apparatus100 is typically delivered to the heart valve percutaneously (e.g., transcatheterally and/or transluminally).Apparatus100 is shown being delivered transluminally from an upstream side of the valve (e.g., via the inferior vena cava). That is, typically, from the perspective of the operating physician, the upstream side of the valve is the proximal side of the valve, and the downstream side of the valve is the distal side of the valve. However, it is to be noted that the scope of the present invention includes delivery from a downstream side of the valve (e.g., transapically, or via the aorta), mutatis mutandis.

Reference is now made toFIGS. 8A-15. Typically, device60 (FIGS. 8A-10) and system100 (9A-15) are used in catheter-based procedures or minimally-invasive procedures. For some applications, device60 (FIGS. 8A-10) and system100 (9A-15) may be used in a surgical procedure, e.g., an open-heart procedure.

Reference is made toFIGS. 1A-15. It is to be noted thatdevices22 and60, andsystem100 described herein may be used in any suitable location in the body of the patient. For example,devices22 and60 can be used to secure sutures in any part of the body. Additionally, it is to be noted thatdevices22 and60, andsystem100 described herein may be used in any cardiac valve (i.e., the mitral, the tricuspid, the pulmonary, and the aortic valve) of the patient.

It will be appreciated by persons skilled in the art that the present invention is not limited to what has been particularly shown and described hereinabove. Rather, the scope of the present invention includes both combinations and subcombinations of the various features described hereinabove, as well as variations and modifications thereof that are not in the prior art, which would occur to persons skilled in the art upon reading the foregoing description.

Claims (26)

The invention claimed is:

1. A method for use with a heart valve of a patient, the heart valve including at least two leaflets, the method comprising:

delivering, to a first side of the heart valve, a support, having a leaflet-engaging side;

delivering, to a second side of the heart valve, a plurality of leaflet-piercing elements, wherein one of the first and the second sides of the heart valve is an upstream side of the heart valve, and the other of the first and the second sides of the heart valve is a downstream side of the heart valve;

piercing the leaflets of the valve, from the second side to the first side of the valve, with the leaflet-piercing elements; and

coupling the support to the leaflets by coupling the leaflet-piercing elements to the support, such that the support overlaps more than one leaflet,

wherein delivering the leaflet-piercing elements comprises delivering, to the second side of the valve, a securing element that includes (1) a core, (2) two or more arms, an inner end of each arm being coupled to the core, and the arms extending radially outward from the core, and (3) the leaflet-piercing elements, coupled to respective outer ends of each arm.

2. The method according toclaim 1, wherein delivering the leaflet-piercing elements comprises delivering the leaflet-piercing elements independently of delivering the support.

3. A method for use with a heart valve of a patient, the heart valve including at least two leaflets, the method comprising:

delivering, to a first side of the heart valve, a support that comprises a braided wire mesh and has a leaflet-engaging side;

delivering, to a second side of the heart valve, a plurality of leaflet-piercing elements, wherein one of the first and second sides of the heart valve is an upstream side of the heart valve, and the other of the first and the second sides of the heart valve is a downstream side of the heart valve;

piercing the leaflets of the valve, from the second side to the first side of the valve, with the leaflet-piercing elements; and

coupling the support to the leaflets by coupling the leaflet-piercing elements to the support, such that the support overlaps more than one leaflet.

4. The method according toclaim 1, wherein coupling the securing element to the support comprises sandwiching the leaflets between the securing element and the support.

5. The method according toclaim 1, wherein coupling the securing element to the support comprises coupling the core to the support, and wherein coupling the core to the support facilitates coupling the leaflet-piercing elements to the support.

6. The method according toclaim 1, wherein the core defines a coupling portion, and wherein coupling the securing element to the support comprises coupling the coupling portion of the core to the support.

7. The method according toclaim 6, wherein coupling the coupling portion of the core to the support comprises coupling the coupling portion to the support at the first side of the heart valve.

8. The method according toclaim 1, wherein delivering the support comprises delivering the support in a compressed configuration, and transitioning the support to an uncompressed configuration in which the support is flat.

9. The method according toclaim 1, wherein delivering the support comprises delivering the support in a compressed configuration, and transitioning the support to an uncompressed configuration in which the support is generally circular.

10. The method according toclaim 3, wherein delivering the leaflet-piercing elements comprises delivering, to the second side of the valve, a securing element that includes (1) a core, (2) two or more arms, an inner end of each arm being coupled to the core, and the arms extending radially outward from the core, and (3) the leaflet-piercing elements, coupled to respective outer ends of each arm.

11. The method according toclaim 1, wherein delivering the support comprises:

percutaneously delivering the support while the support is in a generally-cylindrical delivery configuration thereof, and

subsequently, deploying the support into a generally flat deployed configuration thereof.

12. The method according toclaim 1, wherein coupling the leaflet-piercing elements to the support comprises advancing the leaflet-piercing elements into the support.

13. The method according toclaim 1, wherein coupling the leaflet-piercing elements to the support comprises advancing the leaflet-piercing elements through the support.

14. The method according toclaim 1, wherein coupling the leaflet-piercing elements to the support comprises coupling the securing element to the support.

15. The method according toclaim 6, wherein coupling the coupling portion to the support facilitates the coupling of the leaflet-piercing elements to the support.

16. The method according toclaim 6, wherein the support defines an inner perimeter that defines an opening through the support, and wherein coupling the coupling portion of the core to the support comprises securing at least part of the coupling portion within the opening.

17. The method according toclaim 7, wherein coupling the coupling portion to the support comprises moving at least part of the coupling portion, from the second side of the heart valve, between the leaflets of the heart valve, to the first side of the heart valve.

18. The method according toclaim 1,

wherein the first side of the heart valve is the downstream side of the heart valve,

wherein the second side of the heart valve is the upstream side of the heart valve,

wherein delivering the support to the first side of the heart valve comprises delivering the support to the downstream side of the heart valve, and

wherein delivering the leaflet-piercing elements to the second side of the heart valve comprises delivering the leaflet-piercing elements to the upstream side of the heart valve.

19. The method according toclaim 1,

wherein the first side of the heart valve is the upstream side of the heart valve,

wherein the second side of the heart valve is the downstream side of the heart valve,

wherein delivering the support to the first side of the heart valve comprises delivering the support to the upstream side of the heart valve, and

wherein delivering the leaflet-piercing elements to the second side of the heart valve comprises delivering the leaflet-piercing elements to the downstream side of the heart valve.

20. The method of according toclaim 1,

wherein delivering the support comprises delivering the support through a catheter, and

wherein delivering the leaflet-piercing elements comprises delivering the leaflet-piercing elements through a delivery sheath distinct from the catheter.

21. The method according toclaim 1,

wherein delivering the leaflet-piercing elements comprises delivering the leaflet-piercing elements through a delivering sheath, and

wherein delivering the support comprises advancing the support, while in a compressed configuration, over the delivery sheath.

22. The method according toclaim 10, wherein delivering the support comprises delivering the support in a compressed configuration, and transitioning the support to an uncompressed configuration in which the support is flat.

23. The method according toclaim 10, wherein delivering the support comprises delivering the support in a compressed configuration, and transitioning the support to an uncompressed configuration in which the support is generally circular.

24. The method according toclaim 10, wherein delivering the support comprises:

percutaneously delivering the support while the support is in a generally-cylindrical delivery configuration thereof, and

subsequently, deploying the support into a generally flat deployed configuration thereof.

25. The method according toclaim 10, wherein coupling the leaflet-piercing elements to the support comprises advancing the leaflet-piercing elements into the support.

26. The method according toclaim 10, wherein coupling the leaflet-piercing elements to the support comprises advancing the leaflet-piercing elements through the support.

Images